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The Aging IndividualThe Aging IndividualChapter 34Chapter 34
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IntroductionIntroduction
• Growing old is not popular in the youth-oriented American culture.
• Sixty-six million “baby boomers” will reach their 65th birthdays by the year 2030 placing more emphasis on the needs of an aging population.
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How Old is How Old is OldOld??
• Our prehistoric ancestors probably had a life span of 40 years with the average life span around 18 years.
• The average life expectancy for a child born in the United States today is 76.3 years for men and 81.1 years for women.
• Myths and stereotypes affect the way in which elderly people are treated in our culture.
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• Whether one is considered “old” must be self-determined based on variables such as attitude, mental health, physical health, and degree of independence.
How Old is How Old is OldOld? ? (cont.)(cont.)
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Epidemiological StatisticsEpidemiological Statistics
• Population– In 2012, Americans 65 years of age or older
numbered 43.1 million representing 13.7 percent of the population.
– By 2040, this number is projected to be about 79.7 million or 21 percent of the population.
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Marital Status• In 2013, 71 percent of men and 45 percent of
women 65 years or older were married.• There were over three times
as many widows as widowers.
Epidemiological Statistics Epidemiological Statistics (cont.)(cont.)
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Living Arrangements• The majority of individuals age 65 years or older live
alone, with a spouse, or with relatives.
Economic Status• More than 3.9 million persons age 65 years or older
were below the poverty level in 2012.
Epidemiological Statistics Epidemiological Statistics (cont.)(cont.)
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Employment• In 2013, 8.1 million Americans age 65 and older were
in the labor force.
Health Status• The number of days in which usual activities are
restricted because of illness or injury increases with age.
• Emotional and mental illnesses also increase over the life cycle.
Epidemiological Statistics Epidemiological Statistics (cont.)(cont.)
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Theories of AgingTheories of Aging
Biological Theories
• Genetic Theory• Wear-and-Tear Theory• Environmental Theory• Immunity Theory• Neuroendocrine Theory
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Psychosocial Theories
• Personality Theory• Developmental Task Theory• Disengagement Theory• Activity Theory• Continuity Theory
Theories of Aging Theories of Aging (cont.)(cont.)
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1. Which statement describes a theory of aging from a biological perspective?
A. Personality traits change gradually but systematically throughout the lifespan.
B. Staying active leads to satisfactory aging.C. Life span and longevity are predetermined
by heredity.D. Old values take on new meanings in keeping
with changing circumstances.
Theories of Aging Theories of Aging (cont.)(cont.)
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• Correct answer: C– According to genetic theory, aging is an
involuntarily inherited process that operates over time to alter cellular or tissue structures. This biological theory suggests that life span and longevity are predetermined.
Theories of Aging Theories of Aging (cont.)(cont.)
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The Normal Aging ProcessThe Normal Aging Process
Biological Aspects of Aging • Changes are observed in:
– Skin– Cardiovascular system– Respiratory system– Musculoskeletal system– Gastrointestinal system– Endocrine system– Genitourinary system– Immune system– Nervous system– Sensory system
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Psychological Aspects of Aging
• Memory Functioning
– Short-term memory seems to deteriorate with age, but long-term memory does not show similar changes.
– Time required for memory scanning is longer for both recent and remote recall among older people.
– Mentally active people show less memory decline than those who are not mentally active.
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Psychological Aspects of Aging (cont.)
• Intellectual Functioning
– Intellectual abilities of older people do not decline but do become obsolete.
– The age of their formal educational experiences is reflected in their intelligence scoring.
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Psychological Aspects of Aging (cont.)
• Learning Ability
– Ability to learn continues throughout life, although strongly influenced by interests, activity, motivation, health, and experience.
– Adjustments do need to be made in teaching methodology and time allowed for learning.
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Psychological Aspects of Aging (cont.)• Adaptation to the Tasks of Aging
– Loss and grief• Experience many losses• Mourning has become a lifelong process• Bereavement overload
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Psychological Aspects of Aging (cont.) • Adaptation to the Tasks of Aging (cont.)
– Attachment to others• Social networks contribute to well-being of seniors by
promoting socialization and companionship, elevating morale and life satisfaction, buffering the effects of stressful events, providing a confidant, and facilitating coping skills and mastery.
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Psychological Aspects of Aging (cont.)• Adaptation to the Tasks of Aging (cont.)
– Maintenance of self-identity• Self-concept and self-image appear to remain stable
over time.• Factors that have been shown to favor good
psychosocial adjustment in later life are:– Sustained family relationships– Maturity of ego defenses– Absence of alcoholism– Absence of depressive disorder
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Psychological Aspects of Aging (cont.)• Adaptation to the Tasks of Aging (cont.)
– Dealing with death• Studies show that elderly people do not fear death
itself.• They fear abandonment, pain, and confusion.• Death anxiety among the aging is apparently more of a
myth than a reality.
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Psychological Aspects of Aging (cont.) • Psychiatric Disorders in Later Life
– Neurocognitive disorders– Delirium– Depression– Schizophrenia– Anxiety disorders– Personality disorders– Sleep disorders
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Sociocultural Aspects of Aging• Elderly people in virtually all cultures share some basic
needs and interests:– They choose to live the most satisfying life possible until
their demise.– They want protection from hazards and release from the
weariness of everyday tasks.– They want to be treated with the respect and dignity that is
deserving of individuals who have reached this pinnacle in life.
– They want to die with the same respect and dignity.
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Sociocultural Aspects of Aging (cont.)
• In some cultures, the aged are the most powerful, the most engaged, and the most respected members of the society.
• This has not been the case in the American culture, with the exception of several subcultures, such as Latino Americans, Asian Americans, and African Americans.
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Sexual Aspects of Aging
• Americans have grown up in a society that has liberated sexual expression for all other age groups but still retains certain Victorian standards regarding sexual expression by elderly people.
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Sexual Aspects of Aging (cont.)• Cultural stereotypes play a large part in the
misperception many people hold regarding sexuality of older adults.
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Sexual Aspects of Aging (cont.)• Physical Changes Associated With Sexuality
– Changes in women:• Decline in ovarian function• Reduced production of estrogen• Vaginal dryness• Menopausal symptoms (hot flashes, night sweats,
sleeplessness, irritability, mood swings, migraine headaches, urinary incontinence, weight gain)
• Some women choose to take hormone replacement therapy.
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Sexual Aspects of Aging (cont.)• Physical Changes Associated With Sexuality
– Changes in men:• Decline in testosterone production• Erectile dysfunction• Decrease in testicular size• Decrease in amount of ejaculate• Viable sperm are produced well into old age.
The Normal Aging Process The Normal Aging Process (cont.)(cont.)
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Special Concerns of Elderly PeopleSpecial Concerns of Elderly People
Retirement
• Social Implications• Economic Implications
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Long-Term Care• Potential need for services is predicted by:
– Age– Health– Mental health status– Socioeconomic and demographic factors– Marital status, living arrangement, and the informal
support network
• Attitudinal Factors. Elderly individuals in general are opposed to the use of institutions. Many view them as “places to go to die.”
Special Concerns of Elderly People Special Concerns of Elderly People (cont.)(cont.)
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Elder Abuse• It is estimated that annually up to 2 million
older adults in the United States are victims of abuse.
• The abuser is often a relative who lives with the elderly person and may be the assigned caregiver.
Special Concerns of Elderly People Special Concerns of Elderly People (cont.)(cont.)
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Elder Abuse (cont.)• Factors That Contribute to Abuse
– Longer life– Dependency– Stress– Learned violence
• Identifying Elder Abuse
Special Concerns of Elderly People Special Concerns of Elderly People (cont.)(cont.)
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Suicide• Persons 65 years of age and older represent a
disproportionately high percentage of individuals who commit suicide.
• More than 15 percent of all suicides are committed by this age group.
• The group at highest risk appears to be white men experiencing loneliness, financial problems, physical illness, loss, and/or depression.
Special Concerns of Elderly People Special Concerns of Elderly People (cont.)(cont.)
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Application of the Nursing ProcessApplication of the Nursing Process
Assessment• Assessment of elderly people must consider the
possible biological, psychological, sociocultural, and sexual changes that occur in the normal aging process.
• Age alone does not preclude the occurrence of these changes, and each client must be assessed as a unique individual.
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Diagnosis/Outcome Identification• Nursing diagnoses that relate to physiological
changes in the aging individual may include any or all of the following:– Risk for trauma– Hypothermia– Decreased cardiac output– Ineffective breathing pattern– Risk for aspiration– Impaired physical ability
Application of the Nursing Process Application of the Nursing Process (cont.)(cont.)
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• Physiologically Related Diagnoses (cont.)– Imbalanced nutrition: less than body requirements– Constipation– Stress urinary incontinence– Urinary retention– Disturbed sensory perception– Insomnia– Chronic pain– Self-care deficit– Risk for impaired skin integrity
Application of the Nursing Process Application of the Nursing Process (cont.)(cont.)
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Diagnosis/Outcome Identification (cont.)• Psychosocially related nursing diagnoses may
include
– Disturbed thought processes
– Complicated grieving– Risk for suicide– Powerlessness– Low self-esteem – Fear
– Disturbed body image– Ineffective sexuality
pattern– Sexual dysfunction– Social isolation– Risk for trauma (elder
abuse)– Caregiver role strain
Application of the Nursing Process Application of the Nursing Process (cont.)(cont.)
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Diagnosis/Outcome Identification (cont.)• Outcome criteria are identified for measuring the
effectiveness of nursing care
Application of the Nursing Process Application of the Nursing Process (cont.)(cont.)
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Planning/Implementation• Nursing care of the aging individual is aimed at
protection from injury caused by age-related physical changes or altered thought processes related to cerebral changes.
• The nurse is also concerned with preserving dignity and self-esteem in an individual who may have come to be dependent on others for his or her survival.
Application of the Nursing Process Application of the Nursing Process (cont.)(cont.)
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Planning/Implementation (cont.)• Assistance is provided with self-care deficits
while encouraging independence to the best of the client’s ability.
• Reminiscence therapy is encouraged.
Application of the Nursing Process Application of the Nursing Process (cont.)(cont.)
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Evaluation• Evaluation is based on accomplishment of
previously established outcome criteria.
Application of the Nursing Process Application of the Nursing Process (cont.)(cont.)
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2. An elderly client, newly admitted to a nursing home, refuses to participate in activities of daily living (ADLs). Which nursing intervention would best help the client to be as independent as possible in meeting self-care needs?
A. Assign a variety of caregivers so that one person does not do everything for the client.
B. Establish a specified amount of time for ADL completion.
C. Set client expectations at the beginning of each day.D. Structure the activities of daily living to mirror
previous home routines.
Application of the Nursing Process Application of the Nursing Process (cont.)(cont.)
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• Correct answer: D– Structuring the activities of daily living to mirror
previous home routines can help foster independence in activities of daily living. Maintaining familiar routines will ease the transition to residential care and increase client compliance in meeting self-care needs.
Application of the Nursing Process Application of the Nursing Process (cont.)(cont.)
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3. Which therapy is most effective in decreasing depression in elderly clients?
A. Crisis interventionB. Group therapyC. Orientation therapyD. Reminiscence therapy
Application of the Nursing Process Application of the Nursing Process (cont.)(cont.)
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• Correct answer: D– Reminiscence therapy encourages clients to think
about and reflect on the past. Studies have shown that clients who participate in this therapy have increased self-esteem and are less likely to suffer from depression. Reminiscence therapy helps older adults to work through their losses and maintain self-esteem.
Application of the Nursing Process Application of the Nursing Process (cont.)(cont.)
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